Download National Cancer Programme Update: March 2015

National Cancer Programme Update: March 2015
Welcome to the latest edition of our newsletter, which highlights key areas of our work
programme. Please forward this update to interested colleagues. If you don’t want to receive
these updates, please reply to this email with ‘unsubscribe’ in the subject line.
Faster Cancer Treatment health target results
Performance against the new Faster cancer treatment (FCT) health target was published for
the first time in February, showing that two thirds of patients with a high suspicion of cancer
received their first treatment within 62 days of referral.
The target is that by July 2016, 85 percent of patients receive their first cancer treatment
within 62 days of being referred with a high suspicion of cancer and a need to be seen within
two weeks, increasing to 90 percent by June 2017.
National average performance was 66 percent, with individual district health board (DHB)
results ranging from 50 percent to 82 percent. This is comparable to the results seen in other
countries when a similar target was introduced and provides a baseline from which DHBs
will improve.
The publicly reported performance was based on six months data, covering patients who
received their first cancer treatment between 1 July and 31 December 2014.
Going forward, the quarterly results for the FCT health target will continue to be publicly
reported using six months rolling data. This is in recognition of the target’s defined subset of
cancer patients, and to mitigate the impact that low volumes can have on health target
achievement.
Faster Cancer Treatment Forum
DHBs and regional cancer networks will showcase a selection of successful FCT Service
Improvement Fund initiatives as part of the one-day FCT forum being held in Wellington on
16 April 2015.
The forum will also share progress and achievements implementing the new FCT health
target and increasing equity.
Examples of initiatives being shared include:
 Waitemata DHB will present on its modelling to improve the booking and scheduling
process for cancer patients.

Bay of Plenty DHB will showcase a number of initiatives, including a direct process for
referral to diagnostics, information resources about the cancer journey for Māori patients
and their whānau and the world of electronic pathways.

Counties Manukau DHB will share their work to improve patient pathways and achieve
the 62-day target. This includes development of a prospective electronic track-and-
trigger tool. They will also discuss the philosophy behind the single point of access clinic
(SPOAC) project that is currently underway in the Northern region, and will present some
of the preliminary findings.

Nelson Marlborough DHB will present perspectives from their Māori patient pathway
pilot.
Dr Andrew Simpson, the Ministry’s National Clinical Lead for Cancer and the FCT health
target champion, will speak about the high suspicion of cancer definitions being developed
by the tumour standards working groups, how these will be implemented and how DHBs can
use these definitions to support consistent triaging against the health target.
The day will conclude with a discussion on the Request for Proposal for the second round of
the Service Improvement Fund. Information from this discussion will be written up as in
question and answer format and circulated to DHBs.
The forum is an opportunity for clinical and operational representatives from DHBs and
regional cancer networks to share ideas and learnings and begin planning service
improvement proposals.
Service Improvement Fund
The second round of the FCT Service Improvement Fund begins shortly with a request for
proposal process in April and May 2015.
DHBs and regional cancer networks (RCNs) will have eight weeks to develop and submit
proposals.
Proposals must demonstrate how they will create a sustainable improvement that would
support DHBs to achieve the Faster cancer treatment health target and/or implement the
national tumour standards and/or support equity of access to services.
Contracts for successful proposals are expected to be in place from 1 October 2015, with
funding to be available through to the end of the 2017/18 financial year.
Detailed information on the request for proposal process will be provided to DHBs and RCNs
on 1 April 2015.
Feedback on ‘high suspicion’ of cancer definitions
Feedback is now being sought on draft tumour specific definitions that have been developed
to clarify what constitutes ‘high suspicion’ of cancer under the new Faster cancer treatment
health target.
The draft definitions are the work of the clinically led tumour standards working groups
covering bowel, breast, gynaecological, head and neck, lymphoma, melanoma, myeloma,
sarcoma, thyroid and upper gastrointestinal cancers.
They are designed as a resource for clinicians triaging patients according to the new 62-day
health target, and are not intended to define the urgency of the referral.
The deadline for feedback is Monday 27 April 2015. To see the definitions and provide
feedback please go to Southern Cancer Network website.
Feedback will be discussed by the tumour standards working groups and the Ministry and
used to help refine and finalise the definitions.
Finalised definitions will first be implemented with triaging clinicians in secondary and tertiary
care who have responsibility for confirming whether the flag to indicate ‘high suspicion’ of
cancer has been appropriately applied. The definitions could then be adapted for use in
primary health care.
Faster Cancer Treatment data collection
The National Patient Flow (NPF) team and the Cancer Services team are working closely to
iron out any confusion surrounding collection and reporting of FCT data.
DHBs will need to collect and send both NPF and FCT to the Ministry for at least the next
two years, while work is done to ensure that FCT data in NPF is both robust and consistent.
Once NPF data is reliable, the data the Ministry needs to calculate the FCT health target
achievement at the end of each quarter will eventually be sourced solely from NPF. At that
stage, DHBs will no longer be required to report the health target data separately to the
Ministry.
DHBs will still need to ensure they have systems in place to adequately manage patient
timeframes.
This is because NPF is designed to provide a retrospective and analytical view of a patient’s
journey, rather than a real time view. It will give a retrospective view of how DHBs are
managing their patients and will inform strategic decision-making and operational policy.
During Phase 2 of the NPF Collection, which begins on 1 July 2015, DHBs will need to send
NPF data on any person who receives a first cancer treatment.
The first cancer treatments are defined at this stage as:






Surgery (elective)
Chemotherapy
Radiation therapy
Palliative care
Targeted therapy
Non-intervention management.
It is expected that other treatments not listed above will be reported in Phase 3, which is
scheduled to begin on 1 July 2016.
Colonoscopy numbers up
Significantly more people who need bowel investigations are now receiving a publicly funded
colonoscopy.
In 2014, more than 35,800 people received an outpatient colonoscopy, up from just over
29,000 in 2013 – an increase of more than 20 percent.
Budget 2014 provided $8 million to help DHBs deliver more colonoscopies.
Many DHBs are seeing a drop in the number of people waiting too long for urgent, nonurgent and surveillance colonoscopies. There are also fewer people on colonoscopy waiting
lists nationally.
The number of people waiting for a colonoscopy has dropped by more than 30 percent in the
past 12 months.
Initiatives to increase the endoscopy workforce are underway and consideration is being
given to increased use of CT colonography where appropriate, as an alternative to
colonoscopy for some patients.
Implementation of the Referral Criteria for Direct Access Outpatient Colonoscopy means
people referred for colonoscopy meet the same clinical criteria.
In addition, more than 6000 people have received a colonoscopy through the Waitemata
DHB Bowel Screening Pilot since it began in January 2012.
Cancer patient survival continues to improve
New Zealanders diagnosed with cancer are continuing to survive for longer.
Data in a new Ministry statistical report Cancer Patient Survival – 1994 to 2011, due for
release in April 2015, shows that in 2010/11, 63.3 percent of adult cancer patients survived
five years after diagnosis, up from 57.7 percent in 1998/99.
The one year relative survival rate has also improved, from 74.9 percent in 1998/99 to 78
percent in 2010/11.
Relative survival is the rate of survival among people diagnosed with cancer when compared
with the survival of the general population of the same sex and age.
More than 90 percent of patients with testicular cancer, melanoma, female breast cancer,
prostate cancer, thyroid cancer and Hodgkin lymphoma survived for at least one year, 80
percent survived at least five years and 75 percent survived at least 10 years.
Survival for Māori is improving, but it is still lower than for non-Māori.
The report will be available on the Ministry website in April 2015.
Cancer psychological and social support workforce initiative
DHBs are being asked to work together on regional plans for improved psychological and
social support services for people with cancer.
The plans must have a strong equity focus and outline how the needs of vulnerable
populations will be met.
Budget 2014 provided sustainable funding of $4.2 million a year to build on existing
psychological and social support services across New Zealand.
This included funding for up to 20 new cancer psychological and social support workers and
six new psychologists (for cancer centres in Auckland, Waikato, MidCentral, Capital and
Coast, Canterbury and Southern DHBs).
A national lead is expected to be announced in May 2015. The national lead will be available
to help DHBs recruit to the roles and will provide overall guidance and professional support.
A time limited expert advisory group is guiding the development and implementation of the
initiative.
The new roles will focus on helping patients who are referred to them because of problems
coping with a cancer diagnosis and treatment.
The roles will:

primarily have a clinical focus

have a role in educating other health professionals to further develop or utilise their
skills in providing supportive care, and in improving supportive care systems for
cancer patients

promote collaborative care

sit at the front of the secondary care cancer patient pathway, with links to cancer
nurse coordinators, other allied health services, community health and palliative care.
They will complement existing services, including those provided by NGOs.
Funding for the roles will be made available to DHBs from 1 July 2015.
Bowel Screening Pilot results
Results from the first round (Round 1) of the Bowel Screening Pilot (1 January 2012 to 31
December 2013) have been updated and are available on the Ministry website
Information is now considered final, as enough time has passed to assume that virtually all
people invited in Round 1 of the pilot have completed the screening pathway.
Updated final results show that 55.6 percent of people invited to take part in Round 1 of the
pilot (January 2012 to December 2013) have returned a completed screening test kit.
During Round 1 participation for Pacific people was lower than for other ethnic groups.
Provisional results indicate that this disparity has lessened during Round 2.
Between 1 January 2012 and 30 September 2014 (Round 1 and the first nine months of
Round 2), a total of 167,224 people were invited to take part in the pilot and 90,894 people
returned a correctly completed kit that could be tested by the laboratory.
More than 220 people have had a cancer detected through a colonoscopy delivered as part
of the Bowel Screening Pilot. More than one cancer was found in some people.